The Hidden Root Cause of Low Testosterone, Thyroid Issues & Menopause | Dr. Stephen Cabral

Your bloodwork can come back “normal” while cortisol, nutrient deficiencies, gut dysfunction and hidden immune triggers continue driving exhaustion, weight-loss resistance and hormonal decline. Dr. Stephen Cabral joins Dr. Josh Axe to explain why treating an isolated diagnosis may fail when the real problem is an interconnected biological pattern that standard testing never uncovered. Uncover what’s really going on in your body with advanced biomarker testing for hormones, thyroid, and metabolism— plus a 1-hour consultation with a Senior Health Advisor! → http://mybloodwork.com Thank you to our sponsors! Sunlighten Sauna: https://get.sunlighten.com/axepodcast Manukora Manuka Honey: https://manukora.com/axe Caraway Home: carawayhome.com/drjoshaxe (Use code DRJOSHAXE) for an exclusive discount Watch The Dr. Josh Axe Show every Monday & Thursday on YouTube: https://www.youtube.com/@drjoshaxe?sub_confirmation=1 🎧 Early Access! Our listeners enjoy every episode before anyone else! Tune in below and join our exclusive group of listeners → Spotify: https://bit.ly/DrJoshAxeSpotify Apple Podcast: https://apple.co/3JDvWcS Pre-order my NEW BOOK, Heal Your Cells → https://bit.ly/3QJBcQ5 Watch my free training on how to naturally balance your blood sugar and reverse your symptoms → http://DrAxeDiabetesClass.com Discover practical steps you can take today to start healing your thyroid naturally → http://DrAxeThyroidClass.com If you’re ready to start feeling like yourself again and balance your hormones, take my free class → http://DrAxeHormoneClass.com CONNECT WITH DR. JOSH AXE Instagram → https://www.instagram.com/drjoshaxe/ Facebook → https://www.facebook.com/DrJoshAxe/ TikTok → https://www.tiktok.com/@thedrjoshaxeshow/ X → https://x.com/drjoshaxe/ LinkedIn → https://www.linkedin.com/in/joshaxe Website → http://thehealthinstitute.com Sign up for my newsletter → https://bit.ly/4oE9Jf3 Ask Dr. Axe → http://speakpipe.com/drjoshaxe CONNECT WITH GUEST Instagram → https://www.instagram.com/stephencabral/ Facebook → https://www.facebook.com/drstephencabral YouTube → https://www.youtube.com/stephencabral TikTok → https://www.instagram.com/stephencabral/ X → https://x.com/stephencabral Website → https://stephencabral.com/ 00:00 — Why “Normal” Bloodwork Can Miss the Root Cause 01:46 — Dr. Stephen Cabral on Personalized Root-Cause Medicine 03:28 — How Addison’s Disease, Autoimmunity and Diabetes Became Connected 07:14 — The Cortisol Connection to Thyroid, Testosterone and Blood Sugar 11:11 — How Chronic Stress Disrupts the Entire Hormonal System 14:58 — At-Home Hormone, Thyroid and Metabolism Testing 16:44 — The Three Foundations for Restoring Cortisol Rhythm 20:35 — Why Sleep May Matter More Than Diet 23:36 — When Cold Plunging Can Make Fatigue and Burnout Worse 27:09 — Why 100 Blood Markers May Still Tell You Nothing 30:47 — The Micronutrients That Transformed Dr. Axe’s Energy 33:58 — Dr. Cabral’s “Big Five” Functional Lab Tests 38:39 — Why the Same Diet or Hashimoto’s Protocol Produces Different Results 40:41 — Leaky Gut, Molecular Mimicry and Autoimmune Disease 45:56 — Cortisol, Progesterone and the Root of Menopause Symptoms 49:27 — DHEA, Adaptogens and Restoring Hormone Balance 51:04 — Is Melatonin Safe? Dosage, Sleep and Cancer Research 55:03 — Does Melatonin Shut Down Your Natural Production? 56:25 — The Hidden Side Effects of Testosterone Replacement Therapy 01:00:20 — The Root Causes of Low Testosterone in Younger Men 01:03:55 — How to Identify Your Personal Biological Blueprint 01:06:16 — The Diet and Exercise Combination That May Harm Fertility DISCLAIMER This content is strictly the opinion of Dr. Josh Axe and is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal physician. All viewers of this content are advised to consult their doctors or qualified health professionals regarding s

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  They told me it was all in my head, or I would have to get worse in my blood work in order to be able to find out what it was, because they were running standard blood work. I couldn't fix the type 2 diabetes without first fixing the Addison's. Couldn't fix the Addison's without first fixing the autoimmune issue. So when I look at helping people, one lab is never going to be the answer, because there is no silver bullet approach.

• 0:18Josh Axe?

  And I have men coming to our clinic all the time with low testosterone, and they think it's a testosterone issue.

• 0:22Speaker 00

  Why are there men with great testosterone in their 50s, but some feel like they need to go on TRT in their early 30s?

• 0:27Josh Axe?

  More than any other hormone, it tends to be a cortisol issue. Your body is always making this decision, sex hormones, estrogen, testosterone, progesterone, or do I make cortisol and keep living in survival mode?

• 0:38Speaker 00

  We are not nocturnal beings. I can guarantee you that anyone in the world, you go out into nature for three to four weeks in a tent, you are going to wake up with the sun, you're going to go to bed a couple hours after sunset. People are always like, what's the most important thing in the world? I used to say food, now I say sleep.

• 0:54Josh Axe?

  A lot of people are taking micronutrients or not taking them, and they don't know whether they need them or not.

• 0:59Speaker 00

  Every disease has an underlying root cause. Do we give the person with low thyroid level thyroxine? Do we give the person who's depressed an SSRI? Or do we find out what was missing that leads to those?

• 1:09Josh Axe?

  There are certain nutrients that if I take, which by the way, no conventional blood test, or even my own knowledge would have never told me this. My energy went from a six to a 10, and I'm like, okay, wow, I really noticed a difference.

• 1:19Speaker 00

  Once you know what your body needs, everything is solvable. So that's why you can follow the same diet plan as your friend and not get the same results as them, because that plan or those supplements weren't for your biological blueprint, it's not what your body needed.

• 1:46Josh Axe?

  Hey, everyone. Welcome to the Dr. Axe Show. Today, we're going to dive deep into root cause medicine, how to heal the root cause of every major condition, especially hormone-based conditions in women and men. Also, we're going to talk about lab work. And today I've brought on my friend, Dr. Stephen Cabral. He is a board certified doctor of naturopathy. He's also ran a virtual practice and a company that does Advanced blood work. And today we're going to dive into how do you know for certain what you're dealing with? I see this all the time where people have their labs come back as normal and maybe their doctors have told them it's all in their head and they can't figure out exactly what's going on. Well, on today's show, we're going to dive deep into what the root cause is, how to find the actual root cause. And there are so many people today, you might be

• 2:29Josh Axe?

  one of these people, you're wasting your money on the supplements you're buying, you're wasting your money on buying some of the wrong foods because they're not the things that you actually need. And if you get the right lab work done, then you know exactly what you need. And listen, there are so many companies out there pushing different types of lab work, saying we got 100 plus markers, but they might be the wrong markers. And so today, we're going to talk about this and a whole lot more. Dr. Stephen, welcome to the show.

• 2:53Speaker 00

  So good to be here. Thanks for having me.

• 2:55Josh Axe?

  Well, I was really excited to have you on because I followed you for a long time and been so impressed with the things you put out on your social media channels. And you get a lot into lab work. And this is something that I know you've spent many years developing a expertise in, in knowing what labs to run for what people and running them for the right markers. Share with me a little bit today about your philosophy in terms of the difference between conventional lab work and blood testing versus what you do.

• 3:21Speaker 00

  It's a great question. And so one of the biggest things I found, because I had my own health story, so I won't get too deep into it unless you want to talk about it.

• 3:27Josh Axe?

  Yeah, I'd love to hear about it.

• 3:28Speaker 00

  But from 17 years old to 27 years old, I was dealing with about a dozen diagnosed diseases, right? So we're talking about Addison's disease, which is the inability to produce cortisol. I had rheumatoid arthritis, an autoimmune disease, type 2 diabetes, I had acid reflux, I had allergies, I had mast cell activation syndrome, and I could go on and on. Now, I could say, how can your body feel in that many different ways? Well, the issue is, is it becomes essentially a snowball effect. It's like a domino effect.

• 3:58Josh Axe?

  Yeah.

• 3:58Speaker 00

  You get one disease of the body, you begin to medicate it, and then the body has to find new ways to express that inflammation, which isn't necessarily the underlying root cause, but certainly part of our disease process. So that for me, that started at 17, I saw over two dozen different specialists from 17 to 19, before I even got a diagnosis. They told me it was all in my head, or I would have Have to get worse in my blood work in order to be able to find out what it was because they were running standard blood work, which was essentially your question. So they saw I had one marker off and that was low white blood cells. I had essentially a 1.2 for white blood cells. So they said, okay, does this individual have cancer, right? Blood type cancer? Do they have HIV? What is causing their immune system to be so low? But they never looked for the advanced

• 4:41Speaker 00

  things as Addison's disease, etc. So what I did then, and this is back in the 90s, so no internet yet, at least not in Med for Massachusetts. And so we just stumbled upon a natural health practitioner. This was a naturopathic doctor that studied overseas, came to the US, they were both an MD and an ND, and we ran things such as saliva hormone testing, a cortisol test that was done over the course of a day, so four tubes of saliva essentially. And they found I wasn't producing cortisol. And so then I took that information back to my PCP, who, by the way, brilliant doctor, like Harvard educated, best of the best. But when you only run standard blood work, you basically, if you have one hammer, you have one nail, that's all you can do. That's right.

• 5:23Speaker 00

  So I shared that with him. He said, I don't know what this lab test is, but let's test for Addison's disease. So I do an ACTH stim test, look at my cortisol over three hours, being injected with essentially the same hormone that your hypothalamus tells your pituitary gland to tell your adrenals what to do. I don't want to get too deep in the weeds, but ACTH tells your body to produce cortisol, a glucocorticoid. Well, they injected that in me and I did not produce cortisol. So now I have the diagnosis of Addison's disease. Okay, Addison's disease now doesn't allow me to produce cortisol, and that then does not allow me to then to bring more glucose into my bloodstream. Right. So now I get these wild fluctuations in blood sugar, hence the type 2 diabetes. So I couldn't

• 6:05Speaker 00

  fix the type 2 diabetes without first fixing the Addison's, couldn't fix the Addison's without first fixing the autoimmune issue. So when I look at helping people, one lab is never going to be the answer, because there is no silver bullet approach. You just did an excellent show. I was able to listen to it on the flight down with Dr. Jockers. And you guys are brilliant. I mean, the stuff that you were saying for every different thing is absolutely dialed in. Those are like my top recommendations. But then, and I know you do this as well, how do you narrow that down even more?

• 6:34Josh Axe?

  Yeah.

• 6:34Speaker 00

  You narrow it down even more by looking at functional based labs. And as you did, you talked about in the intro, you can run 100 different markers, but if those 100 markers tell you absolutely nothing, except collect data, what's the point of that? It just adds more confusion to the client. So my job is to look at patterns, not just data markers.

• 6:52Josh Axe?

  Yeah.

• 6:53Speaker 00

  It's to look at across labs, what do I see with this individual that has created a distortion in the human body's rhythm? Cause it essentially comes down to your body's autonomic nervous system, fight or flight, stress, the parasympathetic nervous system, and how that affects every area of your body, including sleep, hormones, blood sugar, and so much more.

• 7:14Josh Axe?

  Yeah, I mean, you, you mentioned a few things here. And one, I want to dive into this sort of cortisol connection with all of your other hormones. And there are so many people today struggling with hypothyroidism, Hashimoto's, type 2 diabetes, menopausal symptoms, you know, low testosterone. And they tend to go to say, you know, and I mean, I have men coming to our clinic all the time with low testosterone. And they think it's just, it's a testosterone issue. And again, it's very similar, women coming in with high estrogen or other things that are like, oh, it's an estrogen issue. When you and I both know, and or I'd love to hear your thoughts on this, more than any other hormone, it tends to be a cortisol issue.

• 7:48Speaker 00

  Agreed.

• 7:48Josh Axe?

  Right? Has that been your experience in practice?

• 7:50Speaker 00

  Absolutely. So, and I, I did not set out, when I set out as a practitioner, so basically for me, it started at 17 years old. I'm 48 now. So for the last 30 years, I've been trying to look for that same silver bullet. But I gave up about 10 to 15 years ago, because what I realized was that there's never one single way that we help somebody heal.

• 8:08Josh Axe?

  Yeah.

• 8:08Speaker 00

  Because it is a natural diurnal rhythm that we need to get back into. So it's essentially, we need to have energy in the morning, specifically as the sun's rising. And we need that energy to fall at night so that we can then produce more melatonin.

• 8:21Josh Axe?

  Yeah.

• 8:22Speaker 00

  Because melatonin is not just a sleep hormone, it is an antioxidant. It helps with the mitochondria. It helps with, it's antiviral, it's anti-cancer. So if your cortisol is elevated at night, which by the way, no standard blood work is going to tell you, you don't know if that is then causing your rise in blood sugar in the morning, right? And glucose overnight can lead to type two diabetes, insulin resistance, type three diabetes, which is Alzheimer's, right? It can also lead to low thyroid because if you have elevated cortisol at night, it throws off thyroid production, which starts around 3am in the morning.

• 8:52Josh Axe?

  By the way, this is, this is key. I just wanted to, the, the, the 3am thing you said, if you're a person that consistently wakes up at 2 or 3 or 4am somewhere in that cycle, it's almost always connected to your cortisol starting to rise too, too early.

• 9:06Speaker 00

  There's an autonomic nervous system dysfunction.

• 9:08Josh Axe?

  Yeah.

• 9:09Speaker 00

  And that's just a fancy way for saying that your day and night rhythm is thrown off.

• 9:13Josh Axe?

  Yeah.

• 9:14Speaker 00

  And I agree because then you study a lot in traditional Chinese medicine. I did internships in Beijing, China, in a TCM hospital. But more of my background is even more in Ayurvedic medicine.

• 9:23Josh Axe?

  Wow.

• 9:23Speaker 00

  But they all say the same thing.

• 9:24Josh Axe?

  Yeah.

• 9:25Speaker 00

  Like if you look at Ayurvedic medicine, TCM, bioregulatory medicine, naturopathy, it is all, if you have a disturbance between that 1:30 and 3 o'clock hour, there's an issue with blood sugar or there's an issue with elevated levels of stress, anxiety, cortisol, but it all still comes back to a stress response.

• 9:41Josh Axe?

  Yeah.

• 9:41Speaker 00

  Ultimately, that's it, right? If you have a drop in blood sugar, well, it's most likely because you are not in a relaxed state overnight. Or you have some type of, coming back to that, blood sugar imbalance caused by accelerated nervous system, which could be anxiety, irritability, overwhelming. I mean, how many of your clients come in or patients saying, I've got low mood, low energy, low libido, irritability, overwhelm, like no ambition, no drive?

• 10:06Josh Axe?

  Yeah, many.

• 10:08Speaker 00

  And that doesn't happen from just low hormones. There's something that's depleting the hormones too early in life.

• 10:13Josh Axe?

  Yeah.

• 10:13Speaker 00

  So why are there men with great testosterone in their 50s, but some feel like they need to go on TRT in their early 30s?

• 10:19Josh Axe?

  Yeah. By the way, that's something that's disturbing lately. We, we had somebody come in, I mean, again, I have somebody come in with this almost every week. Somebody in their 30s and a male and you know, and he's 31 and doctors are just putting him on TRT. I mean, it is, it is.

• 10:35Speaker 00

  I think you and I feel the same way about that.

• 10:37Josh Axe?

  The one thing that drives me so crazy about a lot of, just so much in conventional medicine, they don't see the big picture. They're not thinking long-term. It's like, we want to fix this number now, but I'm not thinking about this man and, and his health and his 40s and his 50s and his 60s and his kids' health, or if he's going to have kids and those types of things in the future. You know, when you, let's dive back to cortisol a little bit more. Tell me a little bit about the pathways, if you're, if you're comfortable doing this in terms of how does cortisol impact all these other hormones? How does cortisol, like, does it impact insulin? What about estrogen? What about testosterone? How does it impact these other hormones?

• 11:11Speaker 00

  So this became a big part of my life's work early on because I had to fix my own cortisol. So I had primary Addison's disease. So the hypothalamus tells the pituitary gland certain signals and they sit right beside each other in the middle of your brain. So if we look at, there's three main axis. There's the hypothalamus-pituitary adrenal axis, hypothalamus-pituitary thyroid axis, and the hypothalamus-pituitary gonad axis or gonadal axis. So that affects the testes in men and the ovaries in women. But the master component, and I know that you actually mentioned this before, is actually the HPA axis. That's the adrenals. So if the adrenals are over firing, which by the way, the adrenals are, you know, they're doing their own thing. Like they're just getting signals. That's literally it.

• 11:55Speaker 00

  But if they are overactive because of the brain and there can be certain stresses, so the stress can be environmental, it could be gut-based, it could be toxicity-based, but there's something telling your body, it's not safe. We need to produce more of this stress hormone. Now, maybe it's drops in blood sugar. There can be a lot of factors for it and we can get into that. But once that happens, you, your adrenals are going to produce two things. One is norepinephrine, so an excitatory neurotransmitter from the medulla, and then from the cortex is going to produce cortisol, which is a glucocorticoid. So that is why when people are stressed, they also tend, chronic stress, they tend to gain weight. It raises your glucose levels, your blood sugar levels, without you even eating carbohydrates, right? Or a large meal. That's its job, is to give you a fuel source that allows you to stay alive. All right.

• 12:40Speaker 00

  So if cortisol rises though, the stress hormone in our body, it actually does a few different things. And it starts with norepinephrine, so that gets your heart rate going, gets your blood pressure going, changes the blood flow, shunts it away from your stomach, right? So then it causes poor digestion. So that's why we shouldn't eat when we're stressed, right? We need to relax the body. So when that happens though, it actually stops the conversion of T4 to T3. Not completely, but it slows it down. Why? Because thyroid is not as important, which is your metabolism, your Your energy, your circulation, we'll get to estrogen in a moment, is not as important for survival. And I would say that it actually, you want to slow those processes so that you burn less calories. There's less movement in the body, right? You're slower, you're

• 13:21Speaker 00

  more sluggish because during a point of starvation or survival, that would be an important thing. So it slows thyroid. So if anybody who has hypothyroidism, you have to look at the adrenals first. And then estrogen, well, what happens with estrogen? Well, thyroid affects it as well. It's downstream of that. But when cortisol is elevated, progesterone levels drop, testosterone levels drop in men, and DHEA becomes lower as well, which affects your immune system. And DHEA, dihydrorepeinesterone, is a precursor for testosterone and estrogen, all three forms. Right? So when we look at this, we say, okay, most women that come into our practice, and men, have elevated levels of cortisol, but specifically in the evening. So they have what's called an inverted or upside down cortisol rhythm.

• 14:06Speaker 00

  So they're lower in the morning, which only happens when you're higher at night, because it's upside down. So in order to get more energy in the morning, it actually starts the night before. And then the biggest thing that we see, because we work with 70% of our practice is women, and many perimenopausal women, I would say perimenopause, menopause, maybe makes up 30% of that. So when we look at it, we say, you are estrogen dominant, yes, but your estrogen is pretty much normal. You're low in progesterone. So you have all the feelings and symptoms of estrogen dominance. Low mood, irritability, bloating, watery tension, hard to lose weights, and sometimes adult based acne. So when we look at that, we say, our job is actually to improve the ratio. And the way that we're going to do that is by improving your HPA axis. So kind of a long answer, but when you look at the

• 14:51Speaker 00

  systems of the body, they then tell you what to do next.

• 14:58Josh Axe?

  Do you have hormone imbalance, weight loss resistance, low energy and sleep problems? And you're tired of being told your labs are normal when you know something isn't right? This new test completely changes things. And my team knows exactly what to look for. I'm currently offering a simple at home blood test. That actually test for the right things, targeted biomarkers, including hormones, thyroid and metabolism. Plus a full hour with one of my senior health advisors to review your results and discover ways that you can work with the Health Institute to finally find lasting healing. If you want to check it out and grab one before they're gone, just go to mybloodwork.com today.

• 15:44Josh Axe?

  You know, there's this pathway in the body and you're very familiar with this and it's this, you know, we refer to this, this may not be completely accurate, but it's called the cortisol steel or the pregnenolone steel, right? Where your body basically makes a decision and this is a part of what you're alluding to. It says, okay, I can either make sex hormones or stress hormones, you know, and progesterone is the one that's most stolen to because that's the one that's most connected to cortisol there with pregnenolone. And so your body is always making this decision, sex hormones, estrogen, testosterone, progesterone, or do I make cortisol and keep living in survival mode? So it's important to break out of that, your body constantly taking all of its resources and shuttling it towards cortisol. Getting practical here, what do you

• 16:26Josh Axe?

  think, let's say the top three things are in ranking order in your mind that start to allow somebody to start shifting away from being so cortisol dominant, or it may be better to say, bringing your body back into cortisol balance and getting the right rhythm back in place?

• 16:44Speaker 00

  Yeah. So the first is with the understanding is the, the human body does have a diurnal rhythm. So we are not nocturnal beings. No matter, and this, again, this is contrarian. A lot of people believe that there are certain chronotypes where some people are night owls. I do not believe this. I mean, we are not apex predators in nature without weapons. We just aren't. We are prey at night. We do not have night vision. We do not have fangs. We do not have claws. We are not a cat. Like it's just like, we are very easy prey at night. We are meant to find shelter at night and we would wake up with the sun. I, I can guarantee you that anyone in the world, you go out into nature for three to four weeks in a tent, you are going to wake up with the sun.

• 17:27Speaker 00

  And you're going after a week of that, you're going to be really tired come six o'clock, seven o'clock, eight o'clock at night. You're going to go to bed a couple hours after sunset. You have no electronics. You have nothing to do. There's no blue light. That's it. You've got the moon. That's all. And so now, what are we doing? Well, we're waking up naturally about eight hours later. Totally normal. A little less in the summer and a little bit more during the winter. That is a natural human dural rhythm. So first, we have to get into natural accordance with that. And that was hard for me. I mean, that is one of the ways that I healed. So I should also say that I have, I've been disease free since 27 years old.

• 18:00Josh Axe?

  Wow.

• 18:01Speaker 00

  I met my mentor around 26, 27 years old. And this is where I learned a lot of this, how to put it all together, integrative health. And what I found was that I had to stop going out with my friends on Friday and Saturday night, staying out till two, three o'clock in the morning. I love my friends. I had an amazing time. It was great. I had to stop doing that in order to heal. Why? For the next three days, couldn't fall asleep at night.

• 18:25Josh Axe?

  Yeah.

• 18:26Speaker 00

  And so then I had to wake up at 4:35 o'clock in the morning for my job. That's what time I had to wake up back then. And I was getting no sleep. No sleep, that's not conducive to repair. So in order for me to overcome the autoimmune issues, which for me, it was mainly gut based and some heavy metals, I could talk about that. I had to fix that. Then the Addison's disease rectified, then the type 2 diabetes. So when I look at cortisol, again, it comes back to what I call a biological signature. So your body is unique. Now, we as humans are all foundational. Again, cortisol rises between six and eight in the morning for all humans. Just depends on the time of the season, right? With the sunrise. And it's going to start to drop and the peak is typically about 9:30 PM. And that means, yes, with lights, with screens,

• 19:09Speaker 00

  with TVs, with whatever, and stress, we can stay up later and we can get a second wind. Because cortisol does start to rise just a little bit after that. But if you do not get in bed essentially between the 10 and 6 hour. It's difficult to overcome chronic disease. So that's the first part is resetting the rhythm of the body. And then whatever you need to do to get to sleep, I had to do a lot to get to sleep.

• 19:31Josh Axe?

  Yeah.

• 19:31Speaker 00

  And that is what you need to do first. After that, there might be nutrients keeping you from decreasing cortisol and allowing yourself to sleep. So let's go through an example. A lot of people say magnesium. I agree. But what is magnesium really good for? It's calming the sympathetic nervous system. So calcium is used to push the sympathetic nervous system as well as sodium. Because both of those are used for a hormone called aldosterone, or at least aldosterone signals those. So it's sodium retention. That's a great thing. We use them in like pre workouts, whatever you want to do and get yourself pumped up, right? And nothing wrong with that. Okay. But magnesium helps to short circuit that. Potassium actually pushes the parasympathetic nervous system. So we have to be careful with someone with fatigue that we're not giving too much potassium. That's why we typically don't supplement with that.

• 20:16Speaker 00

  We allow nature and foods to take the potassium side of it. But we do use magnesium. Okay, so that's one part.

• 20:21Josh Axe?

  Well, and let me mention this too. I mean, you know, there's a study recently on kiwis, you know, being great for sleep because it's one of the most potassium rich foods out there. And so this is why we see something like that. So anyways, I'm glad you're bringing this up because it's, it's powerful.

• 20:35Speaker 00

  And I love, so I am always a food first individual. But so if I could go back, people always like, well, what's the most important thing in the world? I used to would say, I used to say food. I did. Now I say sleep.

• 20:46Josh Axe?

  Yeah, understood.

• 20:47Speaker 00

  And because it's if you don't get proper sleep, then you're going to have elevated glucose in the morning. You're going to have more brain fog, more fatigue, and you're going to make poor choices. You won't want to exercise. You won't have enough energy, drive and ambition to even do the things that we need to do.

• 21:01Josh Axe?

  Well, think about this, like if you eat a meal that's not as healthy, the next day, how do you feel? You may not feel as good, but if you get a poor night's sleep, you're just shot. I mean, people feel wiped, you're moody. I mean, it's, it impacts you even more negatively than a bad meal.

• 21:15Speaker 00

  It disrupts all of your hormones, even if just for that day. Well, then that day is like you just said, shot. It's done.

• 21:21Josh Axe?

  Yeah.

• 21:22Speaker 00

  So I always put sleep first. Okay, then we'll go to nutrition. Then we'll go to nutritional extracts that we call nutritional supplements.

• 21:27Josh Axe?

  Yeah.

• 21:27Speaker 00

  And then for movement, it just starts with walking. So like you could, you have to get the human body. Moving, so it might be moving on a rebound or it might even be doing sauna. Sauna is movement inside of the body without you actually moving, right? It's zone two cardio, getting those heat shock proteins, but it's actually just warming up the body. You talk about it in TCM, I talk about it also from an Ayurvedic perspective, but you can't be cold. You can't be stagnant, you can't be damp, you need to get all of that out of your body. That's why sauna, so a lot of people go through all their favorite biohacking and I love that like any other individual, as long as it's healthy, right?

• 21:58Josh Axe?

  Yeah.

• 21:58Speaker 00

  But sauna is in a class also.

• 22:00Josh Axe?

  Oh, yeah.

• 22:00Speaker 00

  I mean, red light's amazing, cold plunge can be good for some people, not for everybody. But sauna is good for almost everybody. It's just how hot you want to go and how long do you want to stay in it? That's essentially it.

• 22:10Josh Axe?

  It's so true. You know, at the, at our clinic here in Nashville area, we have a, we have something called a Ho, a Ho cap. And basically you are enclosing your entire body in sauna and red light and PMF and getting hydrogen. I mean, all at the same time, but it's really, really powerful. I mean, being able to, and we have a sauna at home and we've used sauna so often over the years and it's powerful. You know, if you think about it too, like, like so many women, I don't know the exact number, but I would say well over 50%. It might be closer to 80, 90% of women, if you take their body temperature, it's below, definitely below 98.6. So many of them, if not majority are in the 97s.

• 22:53Josh Axe?

  And that's one of the things that TCM really teaches too, right? Is you gotta, we, you gotta warm up the body, support movement, blood flow, oxygenation. But typically we need to warm our body. And so if you're a person with cold extremities, if you're a person with low body temperature, with fatigue, you must always need to warm up your body. This is why the cold, when I first started seeing the cold plunge craze, I was like, oh no, like this violates every principle I know in terms of what to do. Now again, you know, I was, I was watching some of the world cup and I was watching some of these athletes and hearing their cold plunge. I'm like, yeah, that makes sense. These guys are running two hours a day, they're lifting weights, they're generating heat. These are males in their twenties, like, you know, they need to cool off their body. But the majority of people, they, you know.

• 23:35Speaker 00

  Completely agree. I mean, to each their own for what they need, right? Like, I mean, that's really what it's about, but yes, males in. Their twenties are literally running hot. And so those individuals can do really well with that, but also you can buffer stress incredibly well in your twenties. Yeah. And cold plunges a massive stress in the body. Yeah. It's producing adrenaline, it's producing massive amounts of norepinephrine. So there are benefits to that, especially like if someone is depressed, it can pull them right out of that, just like exercise. But if you're already worn out, burnt out, low mood, low energy, low libido and cold body temperature. Cold plunging is going to push you temporarily, short term, give you some energy, but in the long term, it's going to make you even worse. Yeah. I mean, it really will because it's another stressor in the body. Yeah.

• 24:17Speaker 00

  So our job is to lessen the stress on the body and provide it with more nutrients of what it does need. And that's the, what leads to specific symptoms, like if we talk about thyroid. So there's only about a dozen reasons as to why someone has low thyroid or Hashimoto's. I mean, only about 12. So now it's our job to say, well, you probably have two to three of those, maybe three to four. You don't have all 12. Yeah. So now we could do all 12 fixes at once, but wouldn't it be nice to narrow that down? That's our job, right? Is to say, I'm going to make this targeted and tailored just for you. So instead of it taking a year, maybe to get better, which would still be great. It's going to take three to four months. Yeah. That's ultimately the goal. And that's what we do with the advanced lab testing. Because when I look at thyroid, I say, okay, is it a mineral deficiency?

• 25:02Speaker 00

  Is it a vitamin deficiency? Is there a gut issue here? Is there a heavy metal? I mean, no conventional medicines that doctors that I know talk about iodine as actually the molecule that makes up thyroid hormone. And how chlorine, mercury, bromine, all block iodine. They displace it, right? Yeah. So if you're swimming in pools all the time, or using a, not using a chlorine filter on your bath or your shower. If you're eating, so for example, one of my issues was that I used to eat a can of tuna. And microwavable rice with the cheapest olive oil you can find in college before bed. Why? I was just trying to put on muscle, right? I was trying to lift, just like a lot of other guys and do all the thing. And so I didn't have any money, so I would get just a stack of tuna cans, which is like 30 cents.

• 25:47Speaker 00

  Microwavable rice, again, horrible, in the plastic bag and olive oil. Well, my mercury levels were through the roof by the time I was 19, 20 years old. If you're eating high mercury foods, you can also displace iodine in the same way. And I had no idea. So it's just, it's these types of things that we look at that are the needles in the haystack. That once we discover them, we know why you have these particular things because every disease has an underlying root cause. It's just usually two to three or three to four. And so we need to figure out all of those and then begin to sequence them. For example, if someone has, let's say like moderate levels of aluminum, like a lot of people have in their body, not ideal, but there's aluminum everywhere in our environment, right?

• 26:30Speaker 00

  It's antiperspirants, it's in the air, it's in foods, it's in dental amalgams, it's everywhere. So, but if it's like moderate, okay, what's more important? Fixing the parasites, fixing the candida overgrowth, the SIBO, the food sensitivities, or the moderate amount of aluminum? Well, let's go for the parasites. Then let's fix the yeast candida overgrowth. Let's heal and seal up that gut wall, improve our own immune system. Now our liver has to do less work with all that detoxification from all the lipopolysaccharides and endotoxemia on a daily basis. And then it could deal with the onslaught of the metals, right? And we could be doing infrared sauna at the same time. So what we try to do is just sequence what needs to be done. But in order to sequence it, we also need to know what needs to be done. And that's the lab testing.

• 27:09Josh Axe?

  Now, let's talk about lab testing a little bit more. I see some companies saying, we do 100 markers or 160 markers. They're doing a lot of markers, but they're not doing a lot of the markers that I would like to see. And I'll give you an example of this. The thing that I like to test most is micronutrient deficiencies. You know, being able to see what is your magnesium level, like RBC magnesium, RBC zinc, you know, selenium, folate, like being able to actually see these nutrients is so valuable to me because a lot of people are taking micronutrients or not taking them and they don't know whether they need them or not. And so that's probably my favorite test that we, that I like to run is looking at these intracellular micronutrients. A lot of times people aren't testing for those. I love omega three index. That's another one I love, you know, being able to look at, um, you know, knowing, you

• 27:54Josh Axe?

  know, homocysteine, MTHFR, these are things that I, I like to, I like to know. And I've never. Seen had somebody come in that I can think of that has actually had those beforehand. I mean, almost every time it's, hey, we've run a CBC, a CMP, you know, these really basic, what's your white blood cells? What's your cholesterol?

• 28:12Speaker 00

  Right.

• 28:12Josh Axe?

  Right? Or liver?

• 28:14Speaker 00

  Yeah, even if it's advanced cholesterol.

• 28:16Josh Axe?

  Yeah.

• 28:16Speaker 00

  Okay, you've got 12 different advanced cholesterol profile that tell you the same thing.

• 28:21Josh Axe?

  That's right.

• 28:21Speaker 00

  And then your CBC, just like you said, is like 12 to 15 different markers, but like almost all saying the same thing. If MCV, MCH, like if all these are off, it's telling you that you have some form of anemia or you just have some oxygenation problem of the red blood cells, right? And so, but it doesn't tell you why.

• 28:38Josh Axe?

  Yeah.

• 28:39Speaker 00

  But the micronutrient test will.

• 28:40Josh Axe?

  Yeah.

• 28:41Speaker 00

  Right? And so when you look at someone with low thyroid, or you look with, look at someone who's feeling low mood, low energy, depressed, might not be producing enough serotonin. So do we give the person with low thyroid, love of thyroxine? Do we give the person who's depressed an SSRI? Or do we find out what was missing that leads to those? So for example, with low thyroid, could be selenium, could be vitamin E, could be zinc, could be vitamin B6, right? Could be iodine. These are all nutrients that thyroid needs. You could be functionally deficient in any one of those. We can test, we can find out what. The next one is for serotonin. I mean, most conventional medicine doctors, and I understand, they have to see 20 to 30 people a day.

• 29:19Josh Axe?

  Yeah.

• 29:20Speaker 00

  It is wild, right? So like, it's not necessarily their fault. They have an XYZ model. Person comes in with these symptoms, we run the blood work, the blood work tells us what medication to give them. That's it. End of story. Right? Then when something goes wrong in the future, we give another medication to fix the compounding issues that we didn't fix in the first place because we didn't get to the underlying root cause. So for serotonin, we know it starts with L-tryptophan, right? And then it becomes five, why am I forgetting this right now?

• 29:43Josh Axe?

  Five HTP.

• 29:44Speaker 00

  Five hydroxytryptophan, exactly. And then it becomes serotonin eventually. And that serotonin actually becomes melatonin eventually.

• 29:50Josh Axe?

  Yeah.

• 29:50Speaker 00

  Well, in order for all that to happen, we need methylated B12, right? We need B9, B2, B3. So these are all our B vitamins.

• 29:57Josh Axe?

  Yep.

• 29:57Speaker 00

  We need zinc, we need selenium, but we also need iron. And so if someone's deficient in iron, it can show up in their CBC as these low oxygenation markers, or copper. Copper's overlooked. People talk negatively about copper.

• 30:11Josh Axe?

  Oh, yeah.

• 30:12Speaker 00

  Or positively about copper, it's like, yeah, it can be both.

• 30:15Josh Axe?

  Yeah.

• 30:15Speaker 00

  Right? So if you have too much copper, it's copper toxicity. It's driving down your thing because everybody has a partner, right? Every mineral is a partner, but you can't produce dopamine. You can't produce these great feel good neurotransmitters, including serotonin without copper. So that CBC gave us a window as to say, there's something an issue here, but it will never tell you why. And the problem is, I talked to a lot of entrepreneurial groups as well, and they love all these new blood work tests, right? Just like you said, 100 biomarkers, 500 biomarkers, 10,000 biomarkers, right? Like whatever it might be, but it's not telling you the underlying root cause.

• 30:47Josh Axe?

  Well, you know, a lot of them too, and you and I know this, most, the average person doesn't know this, but some of these markers cost 25 cents. So they're saying, hey, we're doing 100 markers and they're the cheapest of the cheap markers. And most of them are telling you the exact same thing, especially the cholesterol markers. But there's a test I like to run for oxidative stress and it might be $80. But to be able to tell oxidative stress, do you need glutathione? What form of glutathione do you need? Or, or superoxide dismutase, or what do you need? The value there is so, so beneficial and it's been valuable for me. Like I've noticed for myself, there are certain nutrients that if I take, which by the way, no conventional blood test, or even my own knowledge would have never told me this. If I take vitamin B2, N-acetylcysteine, NMN,

• 31:30Josh Axe?

  those are the three supplements for me that I've noticed, you know, I actually feel radically different. Like my energy went from, when I started taking those from a six to a 10. And I knew that because I actually took a genetic test and I did more advanced blood panels. And I'm like, okay, wow, you know, I really noticed a difference. And I could have been taking every supplement under the sun and I would not have been taking even the right doses of B2 to get my levels up there to where they, you know, needed to be.

• 31:52Speaker 00

  B2 is a really interesting one. So it's fascinating that you say that because more recent research has shown, everybody talks about methylfolate, right? Like it fixes everything in the world.

• 32:01Josh Axe?

  It's the step before.

• 32:02Speaker 00

  Yeah, exactly. But B2 is carrying the methyl donors to where they need to be. And so it's basically like, all right, we need the methyl donors from methylfolate, but we need something to carry that and that B2, B2 does that, riboflavin.

• 32:16Josh Axe?

  Yeah.

• 32:17Speaker 00

  And so that's fascinating and that's why I'm a big advocate. You might need more of others. But you need the whole B complex family.

• 32:24Josh Axe?

  Yeah.

• 32:24Speaker 00

  It's just some of those Bs you need more of it. Or the final form, which is like N M N of B3, right? Or nicotinib, riboside, or however you like to take it. Ultimately, it becomes N A D in the body. But it is all the precursors, like even glutathione. Nothing wrong with taking the liposomal glutathione or whatever it is that you need. But do you need that your entire life? I'm not sure. Eventually, you'll probably overcome the detox based issues that you needed. But you'll always need N L C, N L C, L cystine. You'll always need taurine or selenium or the things that are kind of the sulfur based precursors to that. And so I always like giving the foundational nutrients. And then for a certain period of time, the very specific ones that your body needs.

• 33:02Josh Axe?

  You know, what's interesting is I have one of the M T H F R gene variances of many people do. And I started noticing when I took N R and when I took methylcobalamin, but methylated B12, I felt terrible. I felt that wired, but just exhausted feeling deep down. And it wasn't until I took a genetic test and started looking at things and realizing that, no, I just, I took B2, that fixed it for me. And if I did take B12, taking methylcobalamin wasn't right. I needed to take the hydroxy form. And then I felt fine. But there's a lot of people today that are said, oh, I'm, I'm M T H F R. I'm going to take methylcobalamin. And they don't feel, this is why, again, doing a really advanced testing to be able to look at all these things is so valuable. One other thing I wanted to mention too, or actually multiple things. You do a lot of different lab work.

• 33:46Josh Axe?

  You don't just do, you would do advanced blood work. You do micronutrient, you do all that, you do hormone testing. But I know you also do a lot of G I map. You do heavy metal testing. Talk to me a little bit about the importance of testing the gut microbiome.

• 33:58Speaker 00

  Yeah, so we do something called the big five. Not, I mean, everybody should run it, but not everybody can afford it. And I totally understand that. Even if you can get people the labs at cost, which we do, it's still an expense. And I wish these things were covered by healthcare, but at the same time, I don't. Because then you'd have to play by the rules of healthcare, right? Insurance. And so that is not in the best interest of the patient or the client in most cases. So it's, it's unfortunate. But those consist of the omega three index that you just talked about, omega three and inflammation test. Then we do the hormone testing and that includes estrogen progesterone. The estrogen progesterone ratio, which Is exclusive to women, but really important. Yeah. So you can look at it however you want, but even at menopause, it should be about a 30 to 40 to one ratio of progesterone to estrogen.

• 34:42Speaker 00

  And if it's not, you can still have all the symptoms even on hormone replacement therapy. Cause some women are on massive dosage of HRT when they don't need that massive dosage. A little bit, you know, would do the more they could use herbal based products as well. At least a start or some DHEA as a precursor. But no matter what, you still have to dial in the right ratio progesterone to estrogen to not have those estrogen based symptoms. So then it looks at testosterone, DHEA, cortisol throughout the entire day. Then it looks at T4, T3, TPO antibodies, TSH for your thyroid, hemoglobin A1C and vitamin D3. So that's a really nice hormone test that gives you a lot of that information. Because if vitamin D3 is low, you could be doing everything right. That's right. And not getting that. And some people don't convert it well from a vitamin D lamp. Some people don't convert it well from supplementation.

• 35:27Speaker 00

  Some people don't convert it well from being in the sun. Some people, they just need the cofactors, they're not getting those. And so it's a one that, that should be tested. It's a really important one. I know that you run that a lot as well. I mean, that's crucial that everybody dials that in. And it shouldn't just be 31, right? Just one point within range. So we really want that 50 to 80. Usually in our practice, it's like 50 to 70, but if they are a cancer support client, okay, we'll get that up 80 to 100. But that's, these are specific reasons you want to work with the practitioner on that. So we do a minerals and metals test for the hair and we're looking at mineral and we're looking at heavy metals. That's just an easy way to test. There are advanced labs for all of this, but like we try to do things right at home. So it's easy for people. Yeah. The next one is the food sensitivity test from an IgG perspective.

• 36:12Speaker 00

  So this one's a little bit different. Your body responds to foods essentially in three ways. Immediate reaction. So we think of that as like an IGE or maybe even IGA reaction. It's an immediate reaction. Yep. You get a headache, you get hives or maybe anaphylaxis, which of course would not be good. The next one is an IGM reaction. That's hours later to maybe a day. So it's like kind of an intermediate reaction. And then there's IgG, 24 to 72 hours later. That's what we test for. So that's inflammation created by your white blood cells. Looking at a food as foreign and creating an actual inflammatory reaction in the body. Those are the ones that are hard to know. So let's just say we're recording on a Thursday. I could ask you like, do you remember what you ate Monday night for dinner? Or Tuesday? And you're like, ah, maybe, you know, like, right?

• 36:57Josh Axe?

  Exactly.

• 36:57Speaker 00

  And so that's why we test for those 193 different foods. And the last test is the gut test that we just spoke about. So that's the candida metabolic and vitamins test, also called organic acids testing. And it's looking at about 78 different markers or so. Yeast and candida overgrowth, bacterial overgrowth, even beneficial bacteria. Cause you can have beneficial bacterial overgrowth, but it's still overgrowth in your gut.

• 37:18Josh Axe?

  Yeah.

• 37:19Speaker 00

  Or clostridia, which certainly we don't want built up in the body. That leads to a lot of mood and emotional based issues as well. It looks at mitochondrial function. So the Krebs cycle, citric acid cycle, vitamin levels and much more. So that's our big five. There's many more labs you can do like a stool test. So if you have autoimmune issues, probably want to check for parasites. Check for H. pylori. And so sky's the limit with testing, but we like to run a full gamut on the body. So we get to look at different compartments, what different things are saying within the body. Because remember, we're only, we're not looking for one marker. We're looking for patterns.

• 37:51Josh Axe?

  Yeah.

• 37:51Speaker 00

  And then we're looking to say, what needs to be worked on first? And once we start to push the biggest dominos, we get the biggest effect and everything becomes easier.

• 38:00Josh Axe?

  Yeah. Yeah. There's so much value in knowing what you have going on. There's so many people that are testing. They've gone to 20 different doctors or maybe just a few different doctors. But they've gone years and years without knowing for certain, oh, this is my issue. Versus when you know certainly what you, what your issue is, you know, the exact foods to eat. You know, the supplements to take. Well, some people don't, because some people go and get all this testing done. And then they don't necessarily have the right recommendations.

• 38:23Speaker 00

  That's correct.

• 38:24Josh Axe?

  But when you pair those together, where you have the right testing with the right practitioner. This is where people start to experience healing that maybe they've never, that maybe they even got to the point where they thought, I didn't even think I could heal because it'd been so long and they've been dealing with the problem for, for years.

• 38:39Speaker 00

  That's the thing. So this is early in my just life in my study. I really was, could not understand, let's just take someone with Hashimoto's again, and someone with weight loss issues. So you've got three. People, they're trying to lose 50 pounds. Three people, they all have Hashimoto's. Hashimoto's. So the diagnosis is the same. So this person's over their ideal weight. This person has low thyroid based function, autoimmune issues. So they're given, they're each given the same protocol, the same treatment plan. One person gets better. One person loses the 50 pounds. The other person overcomes Hashimoto's. Okay. The next person gets maybe a little bit of benefit. They lose 10 pounds or they get, they have a little bit less symptoms, but they still have elevated antibodies. And the third people actually get worse.

• 39:20Josh Axe?

  Yeah.

• 39:21Speaker 00

  And when you look at that, you're like, well, we all have the same disease. We all did the specific protocol. Why didn't we all get the same results? And that's essentially what research shows us. Cause when you actually dig into the research, and I know you do this as well, not everybody gets better.

• 39:36Josh Axe?

  That's right.

• 39:36Speaker 00

  It's the average. And so are you the average? We don't know. Right? So that's why you can follow the same diet plan as your friend and not get the same results as them. Because that plan or those supplements weren't for your biological blueprint. It's not what your body needed. And so, once you know what your body needs, everything is solvable. I overcame things that you should not be able to overcome, but it took me 10 years to find those answers. We didn't have, I mean, again, when there was no internet, there was no spread of information. So information now is a luxury we take for granted. All the information is out there. All the data is out there. So it's then how do you parse the data, find the patterns of your unique signature and then work directly on that.

• 40:17Josh Axe?

  Yeah. You know, when you, when you think about something like a woman going through, let's, let's talk about Hashimoto's. Then I want to talk about menopause and low testosterone and then a few others. When you think about the most common, like you were saying, okay, there's, there's these three people. They saw different results. What do you think the most common patterns are or root causes for differing, differing people in terms of Hashimoto's?

• 40:41Speaker 00

  So whenever we look at an autoimmune disease, it does not matter the name of the disease. So we have Hashimoto's, rheumatoid arthritis, lupus, psoriasis, like pick your favorite autoimmune. So that's where genetics matter. So when I look at my family and lineage, all four of my grandparents had rheumatoid arthritis. Both my parents had rheumatoid arthritis. There was a high likelihood I have those genes for rheumatoid arthritis. Right. But I don't have the genes for psoriasis. Right. Or lupus, or whatever it might be, but I do for that autoimmune issue. And I got it at 17. Well, my grandparents didn't get it till they were in their early 60s. My parents got it in their mid to late 40s. I got it at 17 years old.

• 41:25Speaker 00

  That should, that should not happen, but it was still in my genes. Okay. So I had it from 17 years old till about 26, 27 years old. But now I haven't had it for the next 20 years. Same genes, the expression of those genes are different. And it does not matter the name of your disease. So now we need to look at what causes an autoimmune issue. So an autoimmune issue for conventional medicine, they say the immune system, your blood cells are attacking a healthy tissue. In rheumatoid arthritis, it's the joints. In Hashimoto's, it's the thyroid. In MS, it's the myelin sheath of the nervous system. So we just know that the white blood cells are attacking something that they shouldn't. Now, are they messing up? I'd like to believe that they're not messing up. I'd like to believe that we were created, you know, in, in the, the perfect image. Right. The, the right way.

• 42:10Speaker 00

  So what is actually happening? Well, there could be something called molecular mimicry, which means that the body recognizes a foreign antibody or foreign particle such as gluten for some people, casein for others, whatever it might be. And that looks molecular similar to a certain tissue. Or more likely what's happening is that this person, 90% of all autoimmune issues have intestinal permeability, a leaky gut. Doesn't mean it's the only thing, but it is correlated with 90% of all of those. So now the, something spills from your gut called endotoxins. Endo is just within toxins or toxins, right? So, but really what they are is bacteria. That's what they are. So this bacteria now is moving throughout the body.

• 42:53Speaker 00

  And for some people, it seems to maybe land in the joints. For others, it lands in the thyroid. Others, it's the myelin sheath. These are theories right now. But now your white blood cell says, wow, there's something in the thyroid. There's something here. Let's go and destroy that tissue to remove the bacteria. These are CD8 cells, CD4 cells that are specifically doing that. So that's one theory. Either way, here's what we find in practice. Once we get, and the nice thing about the gut is this, there's only five things that can go wrong with it. Like, that's the thing. So it's like, well, five is a lot. Okay, but you can narrow it down, right? And so it's a food sensitivity that's creating that.

• 43:29Josh Axe?

  Yeah.

• 43:30Speaker 00

  And that usually, food sensitivities really only happen, some are innate. You've got a couple, right? Not more than two to three, like foods. It happens when there's already inflammation in the gut. That's inflamed the immune system. So when we look at this, there's food sensitivities, there's candida overgrowth, there's bacterial overgrowth, there's H. pylori, and there's parasites. All those create inflammation in their own way, and then they create intestinal permeability. That's the leakiness. So your intestinal lumen, the outside of your gut wall is literally one cell. And so when we look at this, I love that it's supposed to be mildly permeable to let the good stuff out, but not too permeable. And I love the analogy that it's supposed to be the outside of your body inside your body. So it's a tube that's essentially 26 feet or so long, going from your mouth all the way through essentially your anus, right?

• 44:12Josh Axe?

  Yep.

• 44:12Speaker 00

  And that's only supposed to let the good stuff out. But when it's permeable, it lets bad stuff out, too. That excites the immune system. We know 70%, 80% of the immune system is all around the gut-associated lymphoid tissue around your gut wall. Well, that then sees these particles leaving. It creates massive inflammation, a massive immune reaction, which then leads to, over time, autoimmune issues. So we have to solve that first. It's not the only thing. Could be viral-based, could be heavy metals, could be microplastics, could be whatever is inflaming the body. Over time can lead to these autoimmune issues.

• 44:43Josh Axe?

  Yeah. Yeah, I love that. You know, one of the things I was thinking about as well, and by the way, I agree. I mean, when you look, I think you nailed kind of the 80, 90%. Because when we look at the studies today, it's around, one study said around 80% of patients with hypothyroidism have Hashimoto's, right? There's another study that says nearly 90%. So when we say hypothyroidism, it's almost always autoimmune-based. And I totally agree with that. I was also thinking about, you know, there are some people where there's more of a cortisol issue, and they have this past trauma that's constantly putting them in that mode, which is, can be put them in the autoimmune state, or there's somebody that is nutritionally deficient in iodine, or selenium, or vitamin D, and zinc, or iron, right? That's kind of putting them in that state. But I totally agree with you that the autoimmune

• 45:28Josh Axe?

  Effect is the single greatest factor there. Let's talk about menopause and perimenopause. You know, a woman starts to go through perimenopause and they'll start to say, you know what? I'm noticing these heat fluctuations and hot flashes. I'm noticing dryness of my body and skin and aging more quickly than I had in the past. And some of the other symptoms that accompany that. What do you think are some of the biggest things that a woman could do to rebalance that? Well, not just the ratio, but also just elevate those, those hormones.

• 45:56Speaker 00

  The first and foremost is, is definitely the cortisol scale that we spoke about earlier. So we need to look at how cortisol, especially elevated cortisol near bedtime. So we, we run cortisol upon waking within the first 30 minutes before lunch, before dinner, and then before bed. And so what we want to do is see a natural cortisol wave. So basically for people not watching the video is that it spikes really high in the morning between six and eight. That wakes us up with natural energy. That's how it should work. And then it just falls precipitously, very slowly throughout the whole day till about nine 30 at night. Well, if it does elevate in the evening, that is what's going to not allow for the regeneration of the body overnight. So if we look at ourselves as dinero beans, we should basically be up from seven to seven or basically be on from six to six or seven to seven, somewhere around there. And then we should be off for the other 12 hours. It doesn't mean asleep for 12 hours.

• 46:41Speaker 00

  It just means like not super stressed, right? And so we come home, we have a nice dinner with our family. We laugh, we have good conversation. We hopefully turn down work a little bit, turn down all the noise of the day. And then we start to unwind, relax, have good conversation, maybe take a hot bath or whatever it might be. And then we get into bed for about eight hours or so, whatever it might be for that individual. If you need more healing, you need more hours. If you need less, some people can get away with seven hours, you know, but not most people, if they live a pretty stressful life. So what we first do is we control that HPA axis because that does lower progesterone. And so that's our first thing as to looking at, how do we help the majority of women in perimenopause?

• 47:23Speaker 00

  It's to fix the hormone, which is cortisol, from taking away from the sex hormones that you just mentioned before. So if your body believes it is under stress in a survival based mode, it does not need the levels of estrogen or progesterone, specifically progesterone to carry on life.

• 47:42Speaker 00

  So if you look at progesterone, it's the number one reason for infertility for women. It's not estrogen. So progesterone is what allows for the implementation and healthy uterus of a woman. Like when we look at this. So that is why in the first trimester, they're always monitoring progesterone. It is crucial that it stays elevated, that it stays high enough. And so you or I might use Vitex, Chase Tree Berry, a lot of those great herbs that we know will help with progesterone. Wild yam cream, like whatever you want. And obviously in conventional medicine, they'll use a progesterone pellet or something like that. And again, they can work. But do we need those if we are doing the things that allow for natural production of progesterone later?

• 48:26Speaker 00

  And then we eventually say, well, all women are eventually going to go lower in estrogen progesterone and even testosterone to a degree. So what do we do at that point? We use herbals in our practice. So there are specific phytoestrogens. You've mentioned them. I heard that on the show with Dr. Drucker's. You're using, I mean, there's so many different herbs like black cohosh, et cetera, right? That you can use. You can soy, the isoflavones, all these things that can actually be protective. And they work for some women and some men, and they don't for others. And so you kind of figure out what works for the individual. But we also use DHEA. So not everybody's into that product. Do you need it when you're 22 years old? Probably not, right? But when your natural production is falling and the only way that you would actually make estrogen and progesterone

• 49:10Speaker 00

  when you're in menopause is from DHEA essentially.

• 49:13Josh Axe?

  Right.

• 49:13Speaker 00

  We just help it out a little bit. Do you need 100?

• 49:15Josh Axe?

  And one of the important things to know just about DHEA, just for everybody listening, is that it's what your body needs to make estrogen and progesterone and testosterone. Well, I mean, more specifically estrogen and testosterone. But yeah, yeah.

• 49:26Speaker 00

  But you're right, because, but if you, because you only have so much hormone, right? So if you can't satisfy testosterone and estrogen needs, well, there won't be enough progesterone as well. So if you can give some DHEA, so the clinical research shows 50 to 100 milligrams a day. We start with five milligrams twice a day. We do a small dose. We retest in about eight weeks. How do your levels look now? Oh, they've improved a little bit. Still need a little bit more. We'll go to 10 and 10. And we'll continue to go as much as we need as a precursor because it's a pro hormone. It's not the hormone itself to satisfy that. Well, at the same time, using, we use a product called adrenal soothe, but it's, I mean, what is it? Like, these are just names, right? So it's ashwagandha at a clinical dosage of 600 milligrams. It's fosilserine. It's L-theanine. There's a few others in there like a luthero, et cetera.

• 50:11Speaker 00

  But those are clinically proven to decrease cortisol by about 36%.

• 50:15Josh Axe?

  Yeah.

• 50:15Speaker 00

  Right? So like, okay, now we're decreasing cortisol. Add a little magnesium at dinner for, I'm just giving a general plan, but a general plan is helpful for other individuals. And then we'll use melatonin at night. I mean, to me, melatonin was a game changer. Not for everybody. Some people, they get adverse results from it. Not everybody needs it. But here's what I can tell you. The research shows is that after the age of about 27 years old, it's funny, at 27 years old, again, it's an average age. It's somewhere between 25 and 30. Women stop creating new bone for the most part.

• 50:47Josh Axe?

  Yeah.

• 50:47Speaker 00

  New muscle. Like at that age, we just start to become a little bit more catabolic. And so melatonin drops by about 10% production per decade after your twenties. By the time you get to 70 years old, no matter who you are, you're producing about 20 to 30% of the melatonin you did when you were in your twenties.

• 51:04Josh Axe?

  Let me ask you this. You know, I'm always very cautious and very, um, let me just use the word cautious about hormones. DHEA, melatonin in terms of, because there is some evidence that your body will stop producing it as much on its own. But a lot of this is dose dependent. And so one thing, you know, there's a study that came out last year on melatonin. You're, I'm sure aware of this. On people that took melatonin tend to have higher instances of mortality. Now, the reason I believe was due to association, not cause and effect. Due to if somebody is not sleeping well and they're having to take Ambien and melatonin, all these things. Well, yeah, your, your risk of dying goes up dramatically.

• 51:46Josh Axe?

  Not because you took melatonin, but because you're not sleeping or sleeping well. All that being said, I've also seen other studies on. Dosage. I know somebody who does ultra-high dosing. I want to say over 100 milligrams. I know that grams. I know that typically the dosage is about five grams, right? Or so of melatonin. But I've also seen recently, there was some study that said, if you're doing below one gram, your body will probably still keep producing it on its own. Were you doing more of that? Again, kind of microdosing of melatonin? What's your opinion on all that when it comes to the melatonin dosage?

• 52:24Speaker 00

  Yes. So that study you're talking about is exactly right. It was associative. These individuals had heart disease. And when you're not sleeping, there's a whole lot of inflammation and other issues going on in the body. So there are always going to be studies that are indicated or contraindicated. And that's why it's still based on the individual.

• 52:43Josh Axe?

  And let me say this too, in favor of it. There are studies on rectal cancer, colon cancer, of it increasing survival and overall health. So there are studies, of course, on melatonin supplementation, most particularly for cancer and increasing survival. But

• 52:56Speaker 00

  Cancer, many, many others. I agree. But like, so I look at hormones the same exact way. But also in general, with supplementation. So I just want to state too, I have something called, I use the de-stress protocol. Diet, exercise, stress reduction, tox removal, rest, emotional balance, and success mindset. Supplements is one of the eight. Yeah. So we talk about supplements because it moves the needle the fastest, truthfully. If I need to get you to sleep, I can give you meditations, I can give you breath work, I can give you mantras, I can give you all sorts of different things. But if I want to get you to sleep, and I don't want to do it with Ambien, or which I used to be, I used to be on Ambien and Lunesta. Yeah, horrible, horrible drugs. It shuts down REM sleep, and you're gonna, it's gonna lead to early Alzheimer's. Like, again,

• 53:39Speaker 00

  these are terrible things. But we need to get to sleep. So I'll use herbs and these things in the short term. And usually, I'm having people use melatonin for six to 12 weeks, and I'm weaning off. And I don't do mega dosages of any vitamins or minerals. Yeah, I give you just a little bit, and then I wean up to what you need. So we'll start at one to two milligrams of melatonin.

• 53:58Josh Axe?

  Very small production.

• 53:59Speaker 00

  Yep. 40 milligrams or more is what they're using in cancer studies. At most for people, I'm using five milligrams. If they get COVID, or they get something like that, I'll do 10 milligrams for three weeks, because that has been shown in clinical studies to act as an antiviral, to help with inflammation in the body. So very powerful. But again, Same exact, does, do people, everybody in my practice use DHEA? No, not even because it's not a hormone, it's a pro hormone. But if you don't need it, you don't use it.

• 54:28Josh Axe?

  Yeah.

• 54:29Speaker 00

  So that's how I look at it. What was your question?

• 54:32Josh Axe?

  Well, no, I mean, it's, I just wanted to hear your, your philosophical reasons and dosage and what you do with people. And by the way, I like what you're doing because again, a lot of times people go into conventional medicine. It's like, you're going to be on this drug the rest of your life. Okay. You know, and versus what you're doing is saying, hey, listen, there's a pathway here. We're doing a six week, we're doing a 12 week, we're doing this dosage, we're starting here, we're changing, you know? And this is how people are fluctuating, they're changing during this time that they're changing their diet. And we're trying to reverse the condition. And so, no, I just wanted to hear your.

• 55:03Speaker 00

  And the interesting thing I did want to state, because I actually did not know this previously, is that melatonin is one of the few hormones, we'll call it that, that will not stop your own production of melatonin. So there is positive and negative feedback loops in the body. So if you are producing enough melatonin, your pineal gland, where it's essentially secreted, will get the signal that it doesn't need to do any more work. But your pineal gland is always based on light and dark. And that's why it is so important that we are in a dark environment, that we have amber lights at night, that we turn off those blue lights. Blue light blocking glasses, I think are great, but unless they're wraparound, you're still kind of getting in some of those blue lights.

• 55:45Speaker 00

  So, but agreed, when we give hormones to the body, it's usually shutting down our own natural production. That's why I hate to see men going on testosterone replacement therapy without finding the underlying root cause. Your testosterone is not coming back for three to six months, if you're lucky. Sometimes one to two years, or sometimes never, if you're old enough. And so that is what I'm dealing with in my practice with a lot of guys that I see, is they're getting the negative detrimental effects that they were never told about.

• 56:13Josh Axe?

  Yeah, like I have somebody right now who their doctor, he came in on, in our, I had one guy came in over 2000 because he was doing his own. He said, I buy it online. I checked him.

• 56:23Speaker 00

  And I'm sure he feels great, by the way, right?

• 56:25Josh Axe?

  Yeah, well, he feels great, but he also is having some, a few issues because of it too. But you know, somebody came in with like. You know, 1300 and, and, and they really should be closer to anyways. There's a lot of different opinions on this, but it was actually causing some negative issues with his blood, you know, his blood and his cholesterol levels. You know, his HDL was dropping all kinds of issues and doctors don't. Most people think when they get on hormone replacement, there are just zero side effects. And this is something I'm interested to hear your thoughts from an Ayurvedic perspective. Cause in Chinese medicine, when you take an exogenous hormone like a testosterone or an estrogen, your body turns off its own internal tap and stops creating itself. And in Chinese medicine, they would say that stops the flow of Qi in the area

• 57:09Josh Axe?

  because now it's not producing it on its own. So there's less of a flow there of energy and ATP, we could call that in, in, in Western medicine. And there are side effects. Now, sometimes the side effects of the medication are better than the side effects of you, you not having the feeling like you want to go out and do things and move. So, so here's kind of my philosophy on hormone replacement therapy. If a man starts taking testosterone at a normal dosage, not very, not exceedingly high. And then they're saying, you know what? I'm going to go start working out now. I'm going to start pursuing my woman. I'm going to start, you know, like it actually, there, there are some positive things that happen that they start doing because of it.

• 57:53Josh Axe?

  I think it makes sense and I think it might, might be worth it for that person for a period of time. But I think if that's not happening, I think that there are definite, definite, especially if you only have a minimal issues. My point is there are side effects.

• 58:07Speaker 00

  There are, and those should at least be explained to the patient before they take it. It's not all upside.

• 58:13Josh Axe?

  Yeah.

• 58:13Speaker 00

  And when you do take it initially, you're like, this has changed my entire life. That's what I hear from people all the time.

• 58:21Josh Axe?

  Yeah.

• 58:21Speaker 00

  And then six months, 12 months, 18 months down the road, they're not always associated with. They get the, we'll just call it thickened blood. They get the increase in LDL cholesterol, which for them is oxidized cholesterol. You start to get the blood sugar issues. So insulin insensitivity, right? That, that those Insulin resistance over time. There's a lot of side effects and come along with liver enzymes being elevated.

• 58:46Josh Axe?

  Yeah.

• 58:46Speaker 00

  And only until recently, men were typically given an injection of testosterone once a week or every two weeks at a massive dosage. Okay, so they are getting, forget about 1,000 or 2,000 as their testosterone. If they were to get measured the next day, it's like 5,000. It's absurd. And then it would just fall over a week or two and then they would get the next injection. That is the most dangerous way to do it for your hearts and long-term health. Finally, more doctors are saying, I'm going to do it daily as a microdose, like your own body would produce it. Because people are saying, there's no difference between testosterone replacement therapy and your own testosterone. That is completely false. I mean, it's even if it's the same number.

• 59:29Speaker 00

  You and I, if we're not, you're not on testosterone, assuming I'm not in testosterone. Okay, so my testosterone rises and falls throughout the day.

• 59:36Josh Axe?

  Yeah.

• 59:37Speaker 00

  If you're on TRT, it does not rise and fall throughout the day. It's always elevated, which is unnatural. And that's why it can cause the side effects. And so what we have to do is we need to look at it, how would this function in a natural human being? Testosterone is going to be elevated in the morning, right? That's a good thing. And then it is going to start to fall and it will start to climb at certain points of the day. That's what we want. The only way to mimic that is with a microdose, a small dose on a daily basis. Or maybe every other day, if you can do it that way. It takes needles or sometimes it's a gel. I'm not as always an advocate of the gels and creams because it's not an exact absorptions. It's not exact dosage. I like exact, so I know the exact variables that I'm trying to control for. But in general, men should not have low testosterone until their mid 50s.

• 1:00:20Josh Axe?

  Yeah, right.

• 1:00:20Speaker 00

  Like, that's it.

• 1:00:21Josh Axe?

  Yeah.

• 1:00:22Speaker 00

  And so if it happens before that, there's an underlying root cause. You can just like, well, I'm a low T guy. I'm a low genetics or whatever. It's not the case. It means there was some issue, which is poor sleep, higher levels of stress, overtraining. That's a big one as well that nobody talks about.

• 1:00:37Josh Axe?

  Yes.

• 1:00:37Speaker 00

  Increased elevations in cortisol, going back to cortisol, lack of zinc, lack of vitamin C. Like, these are all things that produce testosterone. Any one of those is the reason you were low testosterone that your doctor never told you about. So then he put you on TRT. And your testosterone will never come back because you never fix the underlying root cause.

• 1:00:55Josh Axe?

  Yeah. And I would say the same for hormone replacement therapy in women is the thing you want to focus on is, you know, follow Stevens, you know, eight points. Do those things. Change your lifestyle, take the right, eat the right diet, take the right supplements and herbs. Do all of those things perfectly. And then if you're still not where you should be, then maybe you consider it. But for, I think for most, you know, most men with TRT, this really shouldn't even be, most of conversations really shouldn't be happening until someone's in their 60s. But that's just a, you know.

• 1:01:22Speaker 00

  I agree. Yeah. 60s is where we look at it. Mid 60s.

• 1:01:25Josh Axe?

  Yeah, makes sense.

• 1:01:26Speaker 00

  And, uh, so at mid 50s, we'll actually start to supplement, supplement with some of the herbs that will boost testosterone, a little bit of DHEA, but we won't touch hormone replacement therapy.

• 1:01:38Josh Axe?

  Makes sense.

• 1:01:38Speaker 00

  So, um, same exact philosophy. Do everything you can for about six months, maybe eight months. And if at that point you need a little bit of estrogen, an estrogen patch, a very small dosage or progesterone, we'll talk about that. It's not like we're not going to help you in any way.

• 1:01:53Josh Axe?

  Yeah, I think there's time and place. It can be great. Yeah.

• 1:01:55Speaker 00

  Exactly. And so the, the bottom line though, is that if you did everything first through that, and the nice thing about the de-stress protocol is that you don't need to be a hundred percent when any one of those things. I'm not a hundred percent with my diet. I'm not a hundred percent with my exercise, but if I'm 80 to 90% of all of those things, I don't have to be a hundred percent in any one area. And so the whole goal of that is to allow you then to feel more balanced. And then when you do take a medication, because these are medications, you need the smallest possible dose, which then will lead to lowest possible side effects.

• 1:02:24Josh Axe?

  Yeah. Yeah. I, I, I love your personal medicine philosophy. I mean, this is one of the reasons why I had you on the show. This is why you're one of the few people I actually follow online for, uh, for natural medicine. I love, I love your background. And I think that one of the things and one of the reasons why I know you see amazing results in patients and why I have a lot of people who share our philosophy on the show is, is that I really believe that in order for somebody to be their very, very best and heal at their highest level, you have to personalize things for them. It's so critically important because to your point, if even in, you know, I always Kind of try and put things in three buckets. You got conventional medicine and everybody just gets the exact same thing.

• 1:03:06Speaker 00

  That's right.

• 1:03:06Josh Axe?

  You come in with Hashimoto's or hypothyroidism, you're getting on levotiroxin, right? So there's that. Then there's some people that follow more of a natural approach, but they'll say, everybody should be on keto. Everybody should be carnivore. Everybody should take a methylated B complex. And, and that's still the majority of natural medicine today.

• 1:03:24Speaker 00

  Yes.

• 1:03:24Josh Axe?

  Then you have this sort of area that you practice in, that I like to practice in and other, other colleagues of ours who share the same passion. It's this personalized medicine and it's saying, we are going to do everything we can to find the root cause. And it's very, that first domino that's following, we're going to figure that out and we're going to personalize and customize things for you. Your diet, your supplements, your emotional health, all of these things together. And you actually just recently wrote a book on this. Talk to us just, just for, just for a minute about the book and what it does and how it does this.

• 1:03:55Speaker 00

  So my first book, The Rain Barrel Effect was how we get sick and how we can get well. That's the de-stress protocol. But back then, personalized medicine, at-home lab testing, integrative health, whatever you want to call it, wasn't really a thing. And now it is. Now we have the ability to enable people to discover what their underlying root cause is. I talk about it and I've heard, actually heard, I think you referred to as well. It's peeling back the onion.

• 1:04:19Josh Axe?

  Yeah.

• 1:04:19Speaker 00

  So the outside of the onion is, oh, this person has, let's call it high cholesterol, high blood pressure, whatever you want to say. We peel back one and we're like, oh, they have elevated CRP. Oh, they've, they have inflammation. Okay. Well, just means inflammation. Well, we don't know what is causing the elevated CRP, something, right? So then we peel it back again and we say, oh, interesting. This person does have methylation issues. They do have COMT issues. They do have detox issues. They are deficient in these specific nutrients. Peel it back again. Why are they so deficient? Oh, they have massive amounts of stress. They're not getting enough sleep. And you say, okay, well, why is that happening? Oh, they've got some childhood trauma they might be working through. They've got a job that they don't like. They're actually eating on the go. They're fasting 18 hours, 20 hours a day. That's not right for all individuals.

• 1:05:03Speaker 00

  That's creating more stress and more nutrient deficiency on someone who's already stressed and nutrient deficient. Right? So it's like, we start to peel it back. So personomics is the study of you. It's your biological blueprint. It is what you need. And inside of the book, for those people who can't lab test, there are self-assessments every step of the road. So it enables you to find out more about you. It's about self-discovery. And no, it's not just about supplementation. It's about the right nutrition for you. Not everybody should be low carb, high protein. Not everybody should be keto. Not everybody should be, what do you need for you? I can tell you right now, if you are low carb, high protein, that is, we call it more of a dopamine diet, more of a go-go-go stress-based diet,

• 1:05:44Speaker 00

  because starches help calm cortisol. It's the only food group that helps to calm the nervous system to tell you that you're in a safe space. So for those individuals with low thyroid, high cortisol, low progesterone, low testosterone, and you're following carnivore and you're not in your twenties, it's going to start to cause more stress in the body.

• 1:06:04Josh Axe?

  I think this is a major cause with women within fertility today, and I see it a lot. They're following that diet and they're doing CrossFit.

• 1:06:10Speaker 00

  Yes.

• 1:06:10Josh Axe?

  You know, and then, and then they're

• 1:06:12Speaker 00

  Because they coexist, right? If you take, if you do CrossFit, you follow the CrossFit diet.

• 1:06:16Josh Axe?

  It's paleo, it's carnivore, it's something like that. And it's, it's not, it's not ideal for those individuals. Well, I love it. And so the book is personomics. I want to encourage you guys, go and check out, go buy Dr. Stephen's book. It's called personomics. It's on amazon.com. It's in a lot of bookstores all over the country as well. You can find it, personomics there. Dr. Stephen Cabral. And just want to say, everybody, hey, thanks so much for tuning in today, Stephen. And thanks so much for coming on and sharing your wisdom. If you're watching on YouTube, would love to hear, what is the biggest piece of wisdom that Dr. Stephen shared today? Was it something regarding our circadian rhythms? Was it a blood test and nutrients? What you've learned about autoimmune disease? Let us know what you learned here on YouTube. And also want to encourage you, do not forget to share this episode. There are millions of people that know, don't know the truth about functional

• 1:07:01Josh Axe?

  medicine and how to get to the root cause of disease. So think about that one person you know that you can share this with, and don't forget to subscribe as well. Want to say, thanks so much for tuning in here, the Dr. Josh Akshay. And also remember, run out, follow Stephen on his social media page on Instagram. It's Dr. Stephen Cabral, brilliant doctor here of naturopathy and functional medicine. And again, thanks so much for tuning in. We can't wait to see you on the next episode.